Page 27 - Virtual Vascular Vol 3

Widened Mediastinum

Complicated Type B Aortic Dissection with

Rapid Aneurysmal Expansion

• Complicated acute aortic dissection with rapid aneurysmal expansion of
the aortic diameter (usually the false lumen, and arbitrarily set as

≥4.2cm) is an indication for early thoracic stentgraft treatment.

• The aim of the urgent endovascular intervention with covering of the

entry tear and re-entry tears in the aorta is to assist remodeling and

expansion of the true lumen, at the expense of the false lumen

• Large communications or fenestrations (A fenestra is a small opening or

pore, “window” in Latin) between the true and false lumen in a dissected
aorta can be identified in angiogram, and should be covered to

decompress the false lumen in contemporary stentgraft management

• Another method to locate the fenestration is to use intravascular

ultrasound (IVUS)

• Stringent blood pressure control and serial CT surveillance remain the

aim of follow-up treatment of these patients to prevent complications

57 yr old female presented with chest pain,
CXR shows a widened mediastinum (>8cm)

CT Aortogram confirmed aortic dissection
Differential diagnosis: Thoracic aortic aneurysm, Traumatic aortic rupture,

Mediastinal mass (lymph node), tumor, Cardiac Tamponade
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